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AARP Medicare Question and Answer Tool
WHAT IS MEDIGAP INSURANCE?
--------------------------------------------------------------------------------
By
Kimberly Lankford,
AARP
1 Comments
En español
Published January 20, 2023
/ Updated January 29, 2024
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Even though Medicare covers the bulk of your medical expenses after you turn 65,
you’ll still find gaps in its coverage. A Medicare supplement policy, also
called Medigap, can cover many of these expenses:
* Deductibles. Expect to pay a certain amount out of pocket every year
before Medicare Part A and Part B coverage kicks in: $1,632 for Part A if a
patient is admitted to the hospital and $240 for Part B in 2024.
But deductibles aren’t all of it. You’ll still have to pay a portion of the
costs for doctors’ services, long stays in a hospital or a skilled nursing
facility, medical equipment, outpatient care and other services.
* Copayments. The set fee you pay for your health services, such as $25 for a
doctor visit.
* Coinsurance. The percentage of a bill you must pay for a service or medical
equipment, such as 20 percent for an outpatient procedure.
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Medicare pays its share of the Medicare-approved amount for your health care
expenses first. Then Medigap kicks in to help cover your portion of the costs.
Medigap policies are sold by private insurance companies but regulated by
federal and state governments. You’ll pay premiums to the Medigap company you
choose, in addition to premiums you pay Medicare for Part A or Part B.
A big plus for Medigap is you can use any doctor or hospital that accepts
Medicare, unlike private Medicare Advantage plans, which usually have provider
networks and charge more or don’t cover out-of-network providers.
WHAT DO MEDIGAP POLICIES OFFER?
Pays the coinsurance. All Medigap plans cover the 20 percent Part B
coinsurance you otherwise would pay yourself for physician visits and other
outpatient services. They also cover the Part A coinsurance costs for inpatient
hospital stays.
For example, Medicare covers the first 60 days as an inpatient in a hospital,
but you’re responsible for paying the coinsurance for days 61 to 90 ($408 in
2024) and an $816 daily coinsurance after that for up to 60 lifetime reserve
days in 2024.
Covers some deductibles. Most Medigap plans cover the Medicare Part A hospital
deductible, which is $1,632 per benefit period in 2024.
Adds health benefits. Although Medicare won’t cover your hospital stay after
you’ve used up your lifetime reserve, all Medigap policies cover the daily
coinsurance costs and up to 365 additional lifetime days in the hospital after
your Medicare benefits are depleted. All Medigap plans cover the first three
pints of blood you may need each year, either in full or in part.
May cover other costs. Some plans pay coinsurance costs for skilled nursing
facilities and hospice care; excess charges from doctors who don’t accept
assignment, which means they can charge up to 15 percent more than the
Medicare-approved amount; and foreign travel health care emergencies.
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HOW WILL I KNOW WHAT PLANS OFFER THE BENEFITS I NEED?
It all comes down to the series of letters that designate each plan. In 1992,
the federal government standardized the types of Medigap plans insurers can
offer nationwide.
Today you have 10 options by letter: A, B, C, D, F, G, K, L, M and N. Every plan
with the same letter designation must include the same coverage; premiums can
vary from company to company.
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Even though the letter system offers standardized plans, it can be confusing.
Plans C and F are only available to people who were eligible for Medicare before
Jan. 1, 2020, even if they have not enrolled in Medicare yet.
In the past, Plan F had been the most popular Medigap policy. But a federal law
passed in 2015 prohibited Medigap plans from covering the Medicare Part B
deductible, and the same law also affected Plan C. If you’re looking for a
similar Medigap policy, Plan G is the same as Plan F but doesn’t pay the Part B
deductible.
Plans K, L, M and N have some cost sharing, often in return for lower premiums.
And if you live in Massachusetts, Minnesota or Wisconsin, those three states
created different systems for their plans.
WHEN CAN I BUY A MEDIGAP POLICY?
No time restrictions. You can buy a Medigap policy anytime after signing up for
Medicare Part A and Part B. Medigap plans have no annual open enrollment
period like Medicare Part D and Medicare Advantage plans. But Medigap insurers
in most states can reject you or charge more because of preexisting medical
conditions unless you apply at certain times.
Special considerations. The best time to buy a Medigap policy if you’re 65 or
older is within the six-month period that starts the first day of the month you
enroll in Medicare Part B. During this time, insurers must offer you all the
Medigap policies available in your area at the best rates for your age.
You also have several guaranteed issue rights, which means that you can buy a
Medigap policy regardless of your health and under specific situations.
State differences. Your state may have other periods when you can buy Medigap
policies without questioning your health.
In Connecticut, Massachusetts and New York, you can buy a Medigap policy anytime
regardless of preexisting conditions. A few states let you switch policies
without health questions during certain times of the year.
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Contact your State Health Insurance Assistance Program (SHIP) or your state
insurance department to find out more about your state’s rules.
KEEP IN MIND
Shop around. When looking for a Medigap policy, first decide which letter plan
you want. Then compare premiums for the policies available in your area.
Premiums can vary significantly by insurer, even though each plan with the same
letter designation must have the same coverage. If you’re eligible for
guaranteed issue rights, you can use Medicare’s Medigap Plan Finder for premium
estimates for each plan in your area based on your age, gender, smoking status
and zip code.
Also understand a plan’s pricing structure:
* Attained-age policies have regular premium increases based on age and
inflation.
* Community-rated policies charge the same premium to everyone with the same
policy, regardless of age.
* Issue-age policies base premiums on your age when you buy the policy and can
increase because of inflation.
Medigap and Medicare Advantage don’t mix. If you choose to get your coverage
from a private Medicare Advantage plan rather than original Medicare, you can’t
sign up for a Medigap policy, too.
(Scroll right to see the full chart below)
%{postComment}%
Kimberly Lankford is a contributing writer who covers Medicare and personal
finance. She wrote about insurance, Medicare, retirement and taxes for more than
20 years at Kiplinger’s Personal Finance and has written for The Washington
Post and Boston Globe. She received the personal finance Best in Business award
from the Society of American Business Editors and Writers and the New York State
Society of CPAs’ excellence in financial journalism award for her guide to
Medicare.
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More on Health
How Are Medigap and Medicare Advantage Plans Different?
The two plans contrast greatly, can’t be used together
How Much Does Medicare Cost?
Monthly premiums, other out-of-pocket expenses can add up
The Big Choice: Original Medicare vs. Medicare Advantage
Which path you take will determine how you get your medical care — and how much
it costs
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MEMBERS ONLY
Family Caregiving
Alexa Emergency Assist from Amazon
25% off emergency assistance subscription plans
Learn More
See more Family Caregiving offers >
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Health & Wellness
AARP® Staying Sharp®
Activities, recipes, challenges and more with full access to AARP Staying Sharp®
Learn More
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Health & Wellness
AARP Medicare Resource Center
Helpful resources to manage your current Medicare situation
Learn More
See more Health & Wellness offers >
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234
*
*
*
*
* MEMBERS ONLY
Restaurants
Coupons for Local Restaurants
Find delicious discounts at your favorite nearby restaurants
Learn More
See more Restaurants offers >
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* MEMBERS ONLY
Family Caregiving
Alexa Emergency Assist from Amazon
25% off emergency assistance subscription plans
Learn More
See more Family Caregiving offers >
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* Health & Wellness
AARP® Staying Sharp®
Activities, recipes, challenges and more with full access to AARP Staying
Sharp®
Learn More
See more Health & Wellness offers >
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* Health & Wellness
AARP Medicare Resource Center
Helpful resources to manage your current Medicare situation
Learn More
See more Health & Wellness offers >
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